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术前逐步气腹和肉毒杆菌毒素A用于治疗一名高风险腹股沟阴囊疝区域丧失患者

Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A in a High-Risk Patient With Loss of Domain Inguinoscrotal Hernia.

作者信息

Baco Stanko J, Mišić Jovica, Perunicic Vladan, Mitric Milos, Đukanović Sonja

机构信息

General Surgery, Public Health Institution Hospital "Dr Mladen Stojanović", Prijedor, BIH.

General Surgery, Saint Luke the Apostle Hospital, Doboj, BIH.

出版信息

Cureus. 2024 Sep 3;16(9):e68509. doi: 10.7759/cureus.68509. eCollection 2024 Sep.

DOI:10.7759/cureus.68509
PMID:39238920
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11375979/
Abstract

We present a challenging case of a loss of domain (LOD) inguinoscrotal hernia in a 77-year-old high-risk patient, successfully managed with the complementary preoperative use of progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA) without complications. Giant inguinoscrotal and LOD hernias, particularly in multimorbid patients, are highly complex and require meticulous preoperative preparation. In this case, PPP was performed with ambient air and a gradual increase in insufflation volume, while BTA was injected at three points on each side, with a total dose of 300 IU. This approach facilitated a complication-free increase in abdominal cavity volume and the repositioning of chronically eventrated abdominal contents. The technique proved safe, feasible, and effective, contributing to atraumatic adhesiolysis, reduced operative time, and avoidance of more invasive surgical methods. A Shouldice pure tissue repair was performed, successfully avoiding the need for prosthetic materials.

摘要

我们介绍了一例具有挑战性的病例，一名77岁的高风险患者患有腹股沟阴囊疝的疝内容物缺失（LOD），通过术前联合使用渐进性气腹（PPP）和肉毒杆菌毒素A（BTA）成功治疗，且无并发症。巨大的腹股沟阴囊疝和LOD疝，尤其是在患有多种疾病的患者中，非常复杂，需要精心的术前准备。在该病例中，使用环境空气进行PPP，并逐渐增加充气量，同时在每侧三个点注射BTA，总剂量为300国际单位。这种方法促进了腹腔容积无并发症地增加以及长期脱出的腹腔内容物的复位。该技术被证明是安全、可行且有效的，有助于实现无创伤性粘连松解、缩短手术时间并避免采用更具侵入性的手术方法。进行了Shouldice单纯组织修复，成功避免了使用假体材料的需要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/dcb32b545e4c/cureus-0016-00000068509-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/cb68ccd3aa40/cureus-0016-00000068509-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/7265370c2ee4/cureus-0016-00000068509-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/4a82c06f4e6d/cureus-0016-00000068509-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/bb270a97067a/cureus-0016-00000068509-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/e2260001230a/cureus-0016-00000068509-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/18e744540336/cureus-0016-00000068509-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/4344239b4d08/cureus-0016-00000068509-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/d30409b2e316/cureus-0016-00000068509-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/dcb32b545e4c/cureus-0016-00000068509-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/cb68ccd3aa40/cureus-0016-00000068509-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/7265370c2ee4/cureus-0016-00000068509-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/4a82c06f4e6d/cureus-0016-00000068509-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/bb270a97067a/cureus-0016-00000068509-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/e2260001230a/cureus-0016-00000068509-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/18e744540336/cureus-0016-00000068509-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/4344239b4d08/cureus-0016-00000068509-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/d30409b2e316/cureus-0016-00000068509-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c539/11375979/dcb32b545e4c/cureus-0016-00000068509-i09.jpg

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